Healthcare Provider Details

I. General information

NPI: 1881609477
Provider Name (Legal Business Name): PENSLOW PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N DYSON ST
HOLLY RIDGE NC
28445-8502
US

IV. Provider business mailing address

PO BOX 146
HOLLY RIDGE NC
28445-0146
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-6151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05390
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RANDY SPAINHOOR
Title or Position: OWNER
Credential:
Phone: 910-324-6151